A Tale of Two Cities

A Tale of Two Cities

Quite a week --- from Seattle to DC to Seattle to Edmonton to Seattle --- and can finally give belated thanks for no more travel in 2013! Especially given that it was, no joke, -22F degrees in Edmonton before wind chill. Yowza. Happy to be back home where our cold snap is feeling downright balmy.

What was particularly notable about this week, though, is the contrast between my experience in DC vs. Edmonton. I’m not sure if I can draw any grand conclusions, but the difference was striking and keeps bouncing around in my head.

Monday/Tuesday: Washington, DC

I have had the honor a few times of sitting in with the Institute of Medicine’s Digital Learning Collaborative. This is quite an accomplished group, and I always feel a bit under-qualified when I’m there. The conversation this week was about how to best leverage EHR-sourced and patient-generated information in research settings. A very meaningful problem.

We heard about some novel work going on at places like SAGE, Lumeris, ONC and others, and our moderators did a good job of stimulating good and spirited conversation. But despite a clearly sincere ask for “action” from Reed Tuckson, I honestly didn’t come away feeling like we’d done much. Maybe created a few new connections and sparked some ideas that will get immortalized in reports --- and there is value in that, at least from a group like IOM whose reports actually get read --- but I’m not sure the world will be much different as a result of that session.

And I had to wear a suit, which always bites.

Wednesday/Thursday: Edmonton, AB

After a quick stop back at the ranch on Wednesday morning, I hopped a much smaller plane to Alberta, where I had been invited to attend a workshop of Alberta Health’s PHP public advisory group. “PHP” is the acronym behind MyHealth Alberta, the province’s citizen health portal, much of which happens to be powered under the covers by Microsoft HealthVault.

Unlike here in the States where we’re usually lucky to see a token patient advocate on projects, the folks in this group were many, diverse and personally engaged. I was immediately struck by the sense of shared purpose and bias for action in the room. Individual members of the PHP staff mixed easily on an informal, first-name basis with the advisors. As a good American I’m hesitant to say, but maybe this is a Canadian thing?

Over the course of the day, we reviewed actual (anonymized) health reports and detailed data available in provincial systems, asking questions about what was important to patients, what might need further context, and so on --- to directly inform the prioritization of pulling data from different sources into the portal. We had a detailed conversation about minors and the ideas for managing the ongoing release of information in the face of changing and ambiguous guardianship and maturity levels. The PHP team openly shared progress and roadmap (warts and all) with the group. I got direct feedback on HealthVault from enthusiastic yet pragmatic providers hoping to leverage it for their patients.

In short, it was great. I left energized about the project and the obvious level of commitment shown by the province to this incredibly important work. Wearing a sweater and jeans didn’t hurt either, but I swear that wasn’t the differentiating factor!

I hesitated to write this because, despite my own style bias, I don’t mean to characterize one as “good” and the other as “bad” … fixing the ridiculously broken world of healthcare requires all comers, and the “star power” of the IOM and its participants can be super-powerful in moving policy and other barriers. But I can’t help but wish the balance of talking to doing was tilted a bit differently --- and it’s pretty clear where I personally add the most value.

Next stop 2014, with no end of great work to get done. Go check out the great HealthVault update that we just shipped … and use it to make people and their families safer and healthier. If I can help, just let me know how, and I’ll do my best.

Well stated and well written, as always, Sean. I too have been spending some time up North and will be visiting Toronto in mid-January. Some provinces in Canada are nearing a point where they will spend 50 percent of the provincial budget on healthcare, something one health minister told me is the point of no return. Just as here in the US, something must be done to flatten the cost curve while improving access and quality. You and I both know tech must play a role in this. Thanks for all of your good work. Happy Holidays and Happy New Year.

Bill Crounse, MD

Susan Anderson, Alberta Health

12 Dec 2013 12:38 PM

Sean,

Cold weather or not, we greatly appreciated your participation in our PHP Program meeting this last week. I agree with your comments on the power and energy of having people set aside their professional identites to collaboratively engage in an in-depth conversation;, in particular with focus on public consumers embracing tools and being empowered in their health system.